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Shih KK, Arechiga AB, Chen X, Urbauer DL, De Moraes AR, Rodriguez AJ, Thomas L, Stanton PA, Bruera E, Hui D. Telehealth Preferences Among Patients With Advanced Cancer in the Post COVID-19 Vaccine Era. J Pain Symptom Manage 2024; 67:525-534.e1. [PMID: 38467349 DOI: 10.1016/j.jpainsymman.2024.02.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/30/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Few studies have examined patient preferences for telehealth in palliative care after the availability of COVID-19 vaccines. We examined patient preferences for video versus in-person visits and factors contributing to preferences in the postvaccine era. METHODS This is a cross-sectional survey of patients who were seen at our palliative care clinic between April 2021 and March 2022. Patients were surveyed directly their preference for either video or in-person visits for outpatient palliative care (primary outcome). We also surveyed preferences including convenience, cost, wait time, and perceptions of COVID-19 safety regarding their palliative virtual-video visit. We examined clinical factors associated with preferences with multivariate logistic regression. RESULTS About 200 patients completed the survey. 132 (67%, 95% confidence interval [CI]: 60%, 74%) preferred virtual-video, while 16 (8%) preferred in-person visits during the COVID-19 pandemic. About 120 (61%, 95%CI: 54%, 68%) preferred virtual-video after the pandemic. Patients perceived virtual-video favorably regarding travel and related costs (179 [91%]), convenience (175 [88%]), and wait time (136 [69%]). Multivariable analysis showed concerns for catching COVID-19 from healthcare providers (odds ratio [OR]: 4.20; 95%CI: 1.24-14.25; P = 0.02) and feeling comfortable with computers or mobile devices (OR: 4.59; 95%CI: 1.02, 20.60; P = 0.047) were significantly associated with preferring virtual-video. Patients who were of Hispanic or Latino ethnicity (OR: 0.25; 95%CI: 0.09, 0.71) and had increased dypsnea (OR: 0.74; 95%CI: 0.59, 0.93) were less likely to prefer video over in-person. CONCLUSION Patients expressed strong preference for video over in-person visits in the outpatient palliative care setting.
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Affiliation(s)
- Kaoswi K Shih
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Adrienne B Arechiga
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xi Chen
- Department of Biostatistics (X.C., D.L.U.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana L Urbauer
- Department of Biostatistics (X.C., D.L.U.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aline Rozman De Moraes
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ashley J Rodriguez
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lisa Thomas
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Penny A Stanton
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Hui
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Basile I, Consolo L, Colombo S, Rusconi D, Rampichini F, Lusignani M. Technology to Support Older Adults in Home Palliative Care: A Scoping Review. Am J Hosp Palliat Care 2024; 41:673-690. [PMID: 37473720 PMCID: PMC11032634 DOI: 10.1177/10499091231189502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Today, many older adults use health technologies, approach their final days with laptops, smartphones, and tablets. Telepalliative care is a service that remotely delivers palliative care through videoconferencing, telephonic communication, or remote symptom monitoring. The service meets the needs of patients who want to die at home and reducing unnecessary hospitalizations. The objective of this study is to map the literature on the use of technology by the terminally ill older adult population being cared for at home, to identify which technology systems are in use, to determine how technology can change communication between palliative care professionals and patients, and to explore the strengths or weaknesses patients perceive regarding the use of technology. METHODS We conducted a scoping review following the methodology of Arksey and O'Malley. A literature search was conducted in the MEDLINE, Embase, Web of Science, SCOPUS, PsycINFO, CINAHL, Ilisi and Google Scholar databases. RESULTS Fourteen eligible papers identified various tools available in clinical practice and found that most older adults are comfortable and satisfied using them. Despite being physically distanced from clinicians, patients felt cared for even though eye contact was lacking. Being unfamiliar with technology emerged as a barrier to telepalliative care in addition to difficulties caused by screen size and internet connection problems. CONCLUSIONS Older adults in palliative care at home perceive technology as a means of receiving efficient care. However, future research is needed to investigate what they look for in a technological tool and to develop more suitable technologies for them. CLINICAL TRIAL REGISTRATION The protocol of this study has been published in the Open Science Framework (OSF) preregistrations at https://osf.io/acv7q to enhance replicability and transparency and reduce any publication or reporting bias.
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Affiliation(s)
- Ilaria Basile
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, IRCCS, National Cancer Institute Milan, Milan, Italy
| | - Letteria Consolo
- Bachelor School of Nursing, IRCCS, National Cancer Institute, Milan Italy
| | - Stella Colombo
- Intensive Care Unit, IRCCS, National Cancer Institute, Milan, Italy
| | - Daniele Rusconi
- Urology Unit, IRCCS, National Cancer Institute, Milan, Italy
| | - Flavia Rampichini
- Central Medical and Surgical Pole Library, University of Milan, Milan, Italy
| | - Maura Lusignani
- Associate Professor, Department of Biomedical Sciences for Health, Milan, Italy
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Hayes Bauer E, Schultz ANØ, Brandt F, Smith AC, Bollig G, Dieperink KB. Patient and families' perspectives on telepalliative care: A systematic integrative review. Palliat Med 2024; 38:42-56. [PMID: 38112009 PMCID: PMC10865769 DOI: 10.1177/02692163231217146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
BACKGROUND Telepalliative care is increasingly used in palliative care, but has yet to be examined from a patient and family perspective. A synthesis of evidence may provide knowledge on how to plan and provide telepalliative care that caters specifically to patients and families' needs. OBJECTIVE To synthesise evidence on patients and families' perspectives on telepalliative care. DESIGN A systematic integrative review (PROSPERO #CRD42022301206) reported in accordance with PRISMA 2020 guidelines. Inclusion criteria; primary peer-reviewed studies published 2011-2022, patient and family perspective, >18 years, telepalliative care and English/Danish language. Quality was appraised using the mixed-methods appraisal tool, version 2020. Guided by Toronto and Remington, data were extracted, thematically analysed and synthesised. DATA SOURCES MEDLINE, EMBASE, PsycINFO and CINAHL were searched in March 2022 and updated in February 2023. RESULTS Forty-four studies were included. Analysis revealed five themes; the effect of the Covid-19 pandemic on telepalliative care, adding value for patients and families, synchronous and asynchronous telepalliative care, the integration of telepalliative care with other services and the tailoring and timing of telepalliative care. CONCLUSION Enhanced access to care and convenience, as attributes of telepalliative care, are highly valued. Patients and families have varying needs during the illness trajectory that may be addressed by early integration of telepalliative care based on models of care that are flexible and combine synchronous and asynchronous solutions. Further research should examine telepalliative care in a post-pandemic context, use of models of care and identify meaningful outcome measures from patient and family perspectives for evaluation of telepalliative care.
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Affiliation(s)
- Eithne Hayes Bauer
- Institute of Regional Health Research, Hospital Soenderjylland, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Medical Research Unit, Hospital Soenderjylland, University Hospital of Southern Jutland, Aabenraa, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Department of Clinical Research, Family Focused Healthcare Research Centre (FaCe), University of Southern Denmark, Odense, Denmark
| | - Anders Nikolai Ørsted Schultz
- Institute of Regional Health Research, Hospital Soenderjylland, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Medical Research Unit, Hospital Soenderjylland, University Hospital of Southern Jutland, Aabenraa, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Frans Brandt
- Institute of Regional Health Research, Hospital Soenderjylland, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Medical Research Unit, Hospital Soenderjylland, University Hospital of Southern Jutland, Aabenraa, Denmark
| | - Anthony C Smith
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Faculty of Medicine, Centre for Online Health, The University of Queensland, Australia
| | - Georg Bollig
- HELIOS Klinikum Schleswig, Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, Schleswig, Schleswig-Holstein, Germany
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Karin Brochstedt Dieperink
- Faculty of Health Sciences, Department of Clinical Research, Family Focused Healthcare Research Centre (FaCe), University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
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Mathews JJ, Chow R, Wennberg E, Lau J, Hannon B, Zimmermann C. Telehealth palliative care interventions for patients with advanced cancer: a scoping review. Support Care Cancer 2023; 31:451. [PMID: 37421447 DOI: 10.1007/s00520-023-07907-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Telehealth allows patients to maintain contact with healthcare providers without necessitating travel, and is becoming increasingly utilized. The purpose of this study is to describe the components of telehealth palliative care interventions for patients with advanced cancer before the COVID-19 pandemic; identify any intervention components associated with improvements in outcomes; and evaluate reporting of interventions. METHODS This scoping review was registered on the Open Science Framework. We searched 5 medical databases from inception to June 19, 2020. Inclusion criteria were: age ≥ 18, advanced cancer, asynchronous or synchronous telehealth intervention, and specialized palliative care interventions in any setting. We assessed the quality of intervention reporting using the Template for Intervention Description and Replication (TIDieR) checklist. RESULTS Twenty-three studies met the inclusion criteria: 15 (65%) quantitative (7 randomized controlled trials, 5 feasibility trials, 3 retrospective chart reviews); 4 (17%) mixed methods, and 4 (17%) qualitative. Most quantitative and mixed methods studies were conducted in North America (12/19, 63%), reported on hybrid (in-person and telehealth) interventions (9/19, 47%), and were delivered by nurses (12/19, 63%) in the home setting (14/19, 74%). In most studies that reported improvements in patient- or caregiver-reported outcomes, the content was psychoeducational and resulted in improvements for psychological symptoms. No study provided complete reporting on all 12 TIDieR checklist items. CONCLUSION Telehealth studies are needed that reflect palliative care's mission to provide multidisciplinary team-based care that improves quality of life in diverse settings, and that provide detailed reporting of interventions.
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Affiliation(s)
- Jean Jacob Mathews
- Division of Palliative Medicine, Department of Medicine and Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Ronald Chow
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Ave, 12-300, Toronto, Ontario, M5G 2C1, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Erica Wennberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Ave, 12-300, Toronto, Ontario, M5G 2C1, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Ave, 12-300, Toronto, Ontario, M5G 2C1, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Ave, 12-300, Toronto, Ontario, M5G 2C1, Canada.
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
- Division of Palliative Care, Department of Medicine, University Health Network, Toronto, Ontario, Canada.
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Bauer EH, Schultz ANØ, Brandt F, Smith AC, Bollig G, Dieperink KB. Protocol for an integrative review: patient and families' perspectives on telehealth in palliative care. BMJ Open 2022; 12:e062723. [PMID: 36688736 PMCID: PMC9454006 DOI: 10.1136/bmjopen-2022-062723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Increases in the use of telehealth in palliative care (telepalliative care) prior to, and during, the COVID-19 pandemic have resulted in a proliferation of studies on the topic. While knowledge is building on how providers and recipients adapt to telepalliative care, no reviews have, as of yet, examined telepalliative care from a patient and family perspective. Therefore, the aim of this integrative review is to explore patients and families' perspectives on telepalliative. METHODS AND ANALYSIS An integrative review will be performed inspired by the methodology of Remmington and Toronto from March 2022 to December 2022. Medline, Embase, PsycINFO and CINAHL will be searched for primary peer-reviewed studies that describe telepalliative care from patient and families' perspectives. Limiters will be used for age; 18 years+, time; 10 years, and language; English and Danish. Hand searches of authors of included articles and reference lists of included articles will be performed. Two reviewers will independently screen and appraise selected articles using the Mixed Method Appraisal Tool. Conflicts will be resolved through discussions with a third reviewer. Data will be extracted independently by two reviewers into a data matrix with predefined headings and analysed using thematic analysis. Findings will be reported thematically, summarised into a thematic synthesis and discussed in relation to relevant literature. ETHICS AND DISSEMINATION Ethical approval is not required for this review. Results will be published in an international peer-reviewed journal and presented at a relevant international conference. Reporting of this protocol was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocol checklist and prospectively reported to PROSPERO (CRD42022301206).
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Affiliation(s)
- Eithne Hayes Bauer
- Research Unit, Department of Internal Medicine, Hospital of Southern Jutland Sonderborg Branch, Aabenraa, Denmark
- Institute of Regional Health Research - University Hospital of Southern Denmark, University of Southern Denmark, Aabenraa, Denmark
| | | | - Frans Brandt
- Research Unit, Department of Internal Medicine, Hospital of Southern Jutland Sonderborg Branch, Aabenraa, Denmark
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Georg Bollig
- Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, Helios Klinikum, Schleswig, Germany
| | - Karin Brochstedt Dieperink
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Barriers and enablers of uptake and adherence to digital health interventions in older patients with cancer: A systematic review. J Geriatr Oncol 2022; 13:1084-1091. [PMID: 35752605 DOI: 10.1016/j.jgo.2022.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/30/2022] [Accepted: 06/14/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Digital health interventions (DHIs) provide patients with remote access to healthcare information and services through devices and online portals. Older patients (≥65 years old) with cancer may face difficulties using DHIs due to higher physical and psychological burden, but little is known about their pattern of use. The aim of this systematic review was to synthesise current findings related to user's perception of barriers and enablers to uptake and adherence of DHIs in this population. METHODS A search for English-language primary qualitative and mixed methods studies on uptake and adherence of DHIs among older patients with cancer was conducted on seven databases (CINAHL, Cochrane, Emcare, JBI, MEDLINE, Proquest, and SCOPUS), since inception until September 2021. Relevant data was extracted, appraised using the MMAT tool, and synthesised based on common themes. RESULTS Five studies met the eligibility criteria. All five studies examined barriers and enablers to uptake of DHIs but only two studies examined barriers and enablers to adherence to these interventions. Two themes - usability and perceived usefulness - emerged from all analyses. Usability was measured using system usability scale, ease of use survey, and observation or participant feedback. High usability to uptake was facilitated by minimalist and age-appropriate design. High usability to adherence was facilitated by customisability of DHIs and availability to provide feedback on DHI design. High perceived usefulness to uptake was facilitated by DHIs' ability to provide health information and to connect the patient to their healthcare team. High perceived usefulness to adherence was facilitated by DHIs ability to provide, reminders and contingency plans, reinforce long-term treatment plans, and keep healthcare teams updated on patients' progress. The review was limited by a small number of primary studies and longitudinal studies. CONCLUSION The enablers and barriers to uptake and adherence of DHIs among older patients with cancer followed the same themes (usability and perceived usefulness) found in other populations. The components of usability and perceived usefulness were similar to other populations, rendering the need for more studies to identify factors unique to this population.
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Sato H, Kinoshita M, Tani Y, Kimura T, Osanai T, Osanai H, Ogasawara K. The health economic effects of an imaging technology–based telemedicine system for rural neuro-emergency patient care. Neurosurg Focus 2022; 52:E2. [DOI: 10.3171/2022.3.focus228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
“Join,” an imaging technology–based telemedicine system, allows simultaneous radiological information sharing between physically remote institutions, virtually connecting advanced medical institutions and rural hospitals. This study aimed to elucidate the health economics effect of Join for neurological telemedicine in rural areas in Hokkaido, Japan.
METHODS
Information concerning 189 requests for patient transfer from Furano Kyokai Hospital, a regional rural hospital, to Asahikawa Medical University Hospital (AMUH), an advanced academic medical institution, was retrospectively collected. The Join system was established between Furano Kyokai Hospital and AMUH in February 2019. Data collected from patients between April 2017 and December 2018 were included in the non-Join group, and those collected between February 2019 and October 2020 were included in the Join group. Clinical variables, reasons for patient transfer requests, duration of hospital stay, and medical costs per patient were analyzed between these two groups. Furthermore, clinical characteristics were compared between patients who were transferred and not transferred based on Join.
RESULTS
More patients were discharged < 7 days after transfer to AMUH in the non-Join group compared with the Join group (p = 0.02). When focusing on the Join group, more patients who were not transferred were discharged < 1 week (p < 0.01). On the other hand, more patients required surgery (p = 0.01) when transferred. The ratio of patients whose medical cost was < USD5000 substantially decreased, from 33% for the non-Join group to 13% for the Join group.
CONCLUSIONS
An imaging technology–based telemedicine system, Join, contributed to reducing unnecessary neuro-emergency patient transfer in a remote rural area, and telemedicine with an integrated smartphone system allowed medical personnel to effectively triage at a distance neuro-emergency patients requiring advanced tertiary care.
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Affiliation(s)
- Hirotaka Sato
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
- Department of Neurosurgery, Japanese Red Cross Kitami Hospital, Kitami, Japan
| | - Manabu Kinoshita
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yuji Tani
- Department of Medical Informatics and Hospital Management, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Teruo Kimura
- Department of Neurosurgery, Japanese Red Cross Kitami Hospital, Kitami, Japan
| | - Toshiya Osanai
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Sülz S, van Elten HJ, Askari M, Weggelaar-Jansen AM, Huijsman R. eHealth Applications to Support Independent Living of Older Persons: Scoping Review of Costs and Benefits Identified in Economic Evaluations. J Med Internet Res 2021; 23:e24363. [PMID: 33687335 PMCID: PMC7988395 DOI: 10.2196/24363] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/04/2020] [Accepted: 01/13/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND eHealth applications are constantly increasing and are frequently considered to constitute a promising strategy for cost containment in health care, particularly if the applications aim to support older persons. Older persons are, however, not the only major eHealth stakeholder. eHealth suppliers, caregivers, funding bodies, and health authorities are also likely to attribute value to eHealth applications, but they can differ in their value attribution because they are affected differently by eHealth costs and benefits. Therefore, any assessment of the value of eHealth applications requires the consideration of multiple stakeholders in a holistic and integrated manner. Such a holistic and reliable value assessment requires a profound understanding of the application's costs and benefits. The first step in measuring costs and benefits is identifying the relevant costs and benefit categories that the eHealth application affects. OBJECTIVE The aim of this study is to support the conceptual phase of an economic evaluation by providing an overview of the relevant direct and indirect costs and benefits incorporated in economic evaluations so far. METHODS We conducted a systematic literature search covering papers published until December 2019 by using the Embase, Medline Ovid, Web of Science, and CINAHL EBSCOhost databases. We included papers on eHealth applications with web-based contact possibilities between clients and health care providers (mobile health apps) and applications for self-management, telehomecare, telemedicine, telemonitoring, telerehabilitation, and active healthy aging technologies for older persons. We included studies that focused on any type of economic evaluation, including costs and benefit measures. RESULTS We identified 55 papers with economic evaluations. These studies considered a range of different types of costs and benefits. Costs pertained to implementation activities and operational activities related to eHealth applications. Benefits (or consequences) could be categorized according to stakeholder groups, that is, older persons, caregivers, and health care providers. These benefits can further be divided into stakeholder-specific outcomes and resource usage. Some cost and benefit types have received more attention than others. For instance, patient outcomes have been predominantly captured via quality-of-life considerations and various types of physical health status indicators. From the perspective of resource usage, a strong emphasis has been placed on home care visits and hospital usage. CONCLUSIONS Economic evaluations of eHealth applications are gaining momentum, and studies have shown considerable variation regarding the costs and benefits that they include. We contribute to the body of literature by providing a detailed and up-to-date framework of cost and benefit categories that any interested stakeholder can use as a starting point to conduct an economic evaluation in the context of independent living of older persons.
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Affiliation(s)
- Sandra Sülz
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
| | - Hilco J van Elten
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
| | - Marjan Askari
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
| | - Anne Marie Weggelaar-Jansen
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
- Clinical Informatics, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Robbert Huijsman
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
- Geriant, Heerhugowaard, Netherlands
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Saldivar RT, Tew WP, Shahrokni A, Nelson J. Goals of care conversations and telemedicine. J Geriatr Oncol 2021; 12:995-999. [PMID: 33619000 DOI: 10.1016/j.jgo.2021.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/11/2021] [Indexed: 11/16/2022]
Abstract
Rapid expansion of telemedicine is one of the transformative healthcare consequences of the COVID pandemic. As a result, telemedicine has allowed clinicians to address the needs of older adults with cancer, who faced the highest risks from COVID, while maintaining safety at home. In light of the COVID experience, which is an important source of learning, this article provides guidance on approaches to enhance telemedicine-enabled supportive care for the geriatric cancer patient.
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Affiliation(s)
| | - William P Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Armin Shahrokni
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Judith Nelson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Lin CJ, Ho SH. Prediction of the use of mobile device interfaces in the progressive aging process with the model of Fitts' law. J Biomed Inform 2020; 107:103457. [PMID: 32470695 DOI: 10.1016/j.jbi.2020.103457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 05/01/2020] [Accepted: 05/17/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE As the population ages, so do the potential users of technology, and older adults' behaviors when using mobile device interfaces are becoming increasingly important. A representative model for detecting older adults' behaviors and performance on the use of mobile device interfaces is needed to provide individualized designs. This research aimed to investigate the applicability of the broadly used model of Fitts' law to detect the progressive changes in the use of mobile device interfaces in older adults. The effect of experience with using technology on performance on a Fitts task was also examined. METHOD A sample of 135 older adults was recruited to test the application of Fitts' model to the use of technology by older adult users. Each participant was asked to finish tasks at 9 levels of difficulty, from easy to difficult, in a multidirectional tapping task. Analysis of variance was employed to examine the effect of age on performance on the Fitts task, movement time, and the standard deviation of movement time. Stepwise regression was used to investigate how well age and technology use could predict performance on the Fitts task. RESULT Performance on the Fitts task was sensitive to the gradual changes in abilities with aging. Rather than the amount of experience in using technology, age was the stronger predictor of older adults' performance on the Fitts task. Additionally, compared with the younger groups, the users above 80 years old demonstrated significantly higher behavioral variation during the use of mobile device interfaces. CONCLUSION This research confirmed that Fitts' law is applicable to the evaluation of the effects of aging on the use of mobile device interfaces. Adults above the age of 80 years should be a major focus for special individualized interface design. This finding can inform future designers and researchers in the development of individualized interface designs for older adult users to enhance their user experiences of mobile device technology. RELEVANCE TO INDUSTRY Future designers and researchers can apply the finding on Fitts' law in this research to develop user-friendly interface designs for mobile technology for older adults and thereby improve their user experiences to enhance their independence and quality of life through the use of technology.
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Affiliation(s)
- Chiuhsiang Joe Lin
- Department of Industrial Management, National Taiwan University of Science and Technology, Taipei, Taiwan.
| | - Sui-Hua Ho
- Department of Industrial Management, National Taiwan University of Science and Technology, Taipei, Taiwan; Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Steindal SA, Nes AAG, Godskesen TE, Dihle A, Lind S, Winger A, Klarare A. Patients' Experiences of Telehealth in Palliative Home Care: Scoping Review. J Med Internet Res 2020; 22:e16218. [PMID: 32369037 PMCID: PMC7238080 DOI: 10.2196/16218] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/18/2020] [Accepted: 02/10/2020] [Indexed: 01/20/2023] Open
Abstract
Background Telehealth is increasingly being used in home care and could be one measure to support the needs of home-based patients receiving palliative care. However, no previous scoping review has mapped existing studies on the use of telehealth for patients in palliative home care. Objective The aim of this study was to map and assess published studies on the use of telehealth for patients in palliative home care. Methods A scoping review was conducted using the methodological framework of Arksey and O’Malley. Reporting was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A systematic and comprehensive search of Medical Literature Analysis and Retrieval System Online, EMBASE, PsycINFO, and Cumulative Index to Nursing and Allied Health was performed for studies published between January 2000 and October 2018. Two authors independently assessed eligibility and extracted data. Results The review included 22 papers from 19 studies. Four thematic groupings were identified among the included papers: easy and effortless use of telehealth regardless of the current health condition, visual features that enhance communication and care via telehealth, symptom management and self-management promotion by telehealth, and perceptions of improved palliative care at home. Conclusions The use of telehealth in palliative home care seems to be feasible, improving access to health care professionals at home and enhancing feelings of security and safety. The visual features of telehealth seem to allow a genuine relationship with health care professionals. However, there are contradicting results on whether the use of telehealth improves burdensome symptoms and quality of life. Future research should investigate the experiences of using telehealth among patients with life-limiting illness other than cancer and patients aged 85 years or older. More research is needed to increase the body of knowledge regarding the effectiveness of telehealth on symptoms and quality of life.
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Affiliation(s)
| | | | - Tove E Godskesen
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | | | - Susanne Lind
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | | | - Anna Klarare
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Clinical Psychology in Healthcare, Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Abstract
BACKGROUND There is extensive need for palliative care worldwide, but access to care remains inadequate, especially for non-cancer patients. Video consultations are a promising tool in the provision of home-based palliative care, but an overview of evidence solely on video consultations in palliative care is lacking. AIM To review and synthesize current evidence regarding the use of video consultations in general and specialized palliative care to various patient groups. DESIGN A systematic integrative review with a narrative synthesis was undertaken in accordance with PRISMA (2009) guidelines. PROSPERO #: CRD42018095383. DATA SOURCES PubMed, Embase, CINAHL, and PsychINFO were searched for primary research articles published between 2005 and 2018. In addition, reference lists of included articles were hand searched. RESULTS The search resulted in 813 articles; 39 articles were included in the review, consisting of mixed methods (n = 14), qualitative (n = 10), quantitative (n = 10), and case studies (n = 5). The studies mainly focused on specialized palliative care to adult patients with cancer in high income countries. Through data analysis, six themes addressing advantages/disadvantages and facilitators/barriers were identified: (1) Redesign of care, (2) Communication, (3) User perceptions, (4) Technology, (5) Privacy issues, and (6) Economic implications. CONCLUSION Using video technology in palliative care has both advantages and disadvantages. However, evidence beyond the focus on specialized palliative care and patients with cancer is limited. Future research should focus on how and when video consultations might replace in-person specialized palliative care and video consultations in general palliative care, in low and middle income countries; and involve patients with a non-cancer diagnosis.
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Affiliation(s)
- Mia Jess
- 1 REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Helle Timm
- 1 REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Karin B Dieperink
- 1 REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark.,2 Department of Oncology, Odense University Hospital, Odense, Denmark
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Pinto S, Caldeira S, Martins JC. e-Health in palliative care: review of literature, Google Play and App Store. Int J Palliat Nurs 2017; 23:394-401. [DOI: 10.12968/ijpn.2017.23.8.394] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Sara Pinto
- Palliative Care, PhD student in Nursing Sciences Instituto de Ciências Biomédicas Abel Salazar, University of Porto Centro Hospitalar São João, Porto Portugal
| | - Sílvia Caldeira
- Bioethics Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Instituto de Ciências da Saúde, Lisboa, Portugal
| | - José Carlos Martins
- Coordinator Professor Medical-Surgical Unit, Escola Superior de Enfermagem de Coimbra Department of Human Sciences and Health, Faculdade de Medicina da Universidade do Porto, Oporto, Portugal
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Worster B, Swartz K. Telemedicine and Palliative Care: an Increasing Role in Supportive Oncology. Curr Oncol Rep 2017; 19:37. [PMID: 28417310 DOI: 10.1007/s11912-017-0600-y] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
With the emergence of telemedicine as a routine form of care in various venues, the opportunities to use technology to care for the most vulnerable, most ill cancer patients are extremely appealing. Increasingly, evidence supports early integration of palliative care with standard oncologic care, supported by recent NCCN guidelines to increase and improve access to palliative care. This review looks at the use of telemedicine to expand access to palliative care as well as provide better care for patients and families where travel is difficult, if not impossible. When telemedicine has been used, often in Europe, for palliative care, the results show improvements in symptom management, comfort with care as well as patient and family satisfaction. One barrier to use of telemedicine is the concerns with technology and technology-related complications in population that is often elderly, frail and not always comfortable with non-face-to-face physician care. There remain significant opportunities to explore this intersection of supportive care and telemedicine.
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Affiliation(s)
- Brooke Worster
- Thomas Jefferson University Hospitals, 1015 Walnut St, Suite 401, Philadelphia, PA, 19107, USA
| | - Kristine Swartz
- Thomas Jefferson University Hospitals, 1015 Walnut St, Suite 401, Philadelphia, PA, 19107, USA.
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Akiyama M, Yoo BK. A Systematic Review of the Economic Evaluation of Telemedicine in Japan. J Prev Med Public Health 2017; 49:183-96. [PMID: 27499161 PMCID: PMC4977767 DOI: 10.3961/jpmph.16.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/22/2016] [Indexed: 12/05/2022] Open
Abstract
Objectives: There is no systematic review on economic evaluations of telemedicine in Japan, despite over 1000 trials implemented. Our systematic review aims to examine whether Japan’s telemedicine is cost-saving or cost-effective, examine the methodological rigorousness of the economic evaluations, and discuss future studies needed to improve telemedicine’s financial sustainability. Methods: We searched five databases, including two Japanese databases, to find peer-reviewed articles published between January 1, 2000 and December 31, 2014 in English and Japanese that performed economic evaluations of Japan’s telemedicine programs. The methodological rigorousness of the economic analyses was assessed with a well-established checklist. We calculated the benefit-to-cost ratio (BCR) when a reviewed study reported related data but did not report the BCR. All cost values were adjusted to 2014 US dollars. Results: Among the 17 articles identified, six studies reported on settings connecting physicians for specialist consultations, and eleven studies on settings connecting healthcare providers and patients at home. There are three cost-benefit analyses and three cost-minimization analyses. The remaining studies measured the benefit of telemedicine only, using medical expenditure saved or users’ willingness-to-pay. There was substantial diversity in the methodological rigorousness. Studies on teledermatology and teleradiology indicated a favorable level of economic efficiency. Studies on telehomecare gave mixed results. One cost-benefit analysis on telehomecare indicated a low economic efficiency, partly due to public subsidy rules, e.g., a too short budget period. Conclusions: Overall, telemedicine programs in Japan were indicated to have a favorable level of economic efficiency. However, the scarcity of the economic literature indicates the need for further rigorous economic evaluation studies.
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Affiliation(s)
- Miki Akiyama
- Faculty of Environment and Information Studies, Keio University, Kanagawa, Japan
| | - Byung-Kwang Yoo
- Faculty of Environment and Information Studies, Keio University, Kanagawa, Japan
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Neergaard MA, Warfvinge JE, Jespersen TW, Olesen F, Ejskjaer N, Jensen AB. The Impact of “Modern Telecommunication” in Palliative Care—The Views of the Professionals. Telemed J E Health 2014; 20:24-31. [DOI: 10.1089/tmj.2013.0047] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Jens Erik Warfvinge
- Department of Health Informatics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Frede Olesen
- The Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Niels Ejskjaer
- Department of Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Bonde Jensen
- The Palliative Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Improving access to specialist multidisciplinary palliative care consultation for rural cancer patients by videoconferencing: report of a pilot project. Support Care Cancer 2012; 21:1201-7. [PMID: 23161339 DOI: 10.1007/s00520-012-1649-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/30/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Palliative care (PC) and palliative radiotherapy (RT) consultation are integral to the care of patients with advanced cancer. These services are not universally available in rural areas, and travel to urban centers to access them can be burdensome for patients and families. The objectives of our study were to assess the feasibility of using videoconferencing to provide specialist multidisciplinary PC and palliative RT consultation to cancer patients in rural areas and to explore symptom, cost, and satisfaction outcomes. METHODS The Virtual Pain and Symptom Control and Palliative Radiotherapy Clinic was piloted from January 2008 to March 2011. Cancer patients in rural northern Alberta attended local telehealth facilities, accompanied by nurses trained in symptom assessment. The multidisciplinary team at the Cross Cancer Institute in Edmonton was linked by videoconference. Team recommendations were sent to the patients' family physicians. Data were collected on referral, clinical, and consultation characteristics and symptom, cost, and satisfaction outcomes. RESULTS Forty-four initial consultation and 28 follow-up visits took place. Mean Edmonton Symptom Assessment Scale scores for anxiety and appetite were statistically significantly improved at the first follow-up visit (p < 0.01 and p = 0.03, respectively). Average per visit savings for patients seen by telehealth versus attending the CCI were 471.13 km, 7.96 hours, and Cdn $192.71, respectively. Patients and referring physicians indicated a high degree of satisfaction with the clinic. CONCLUSION Delivery of specialist multidisciplinary PC consultation by videoconferencing is feasible, may improve symptoms, results in cost savings to patients and families, and is satisfactory to users.
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Ludwig W, Wolf KH, Duwenkamp C, Gusew N, Hellrung N, Marschollek M, Wagner M, Haux R. Health-enabling technologies for the elderly--an overview of services based on a literature review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2012; 106:70-8. [PMID: 22115611 DOI: 10.1016/j.cmpb.2011.11.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 11/03/2011] [Indexed: 05/14/2023]
Abstract
BACKGROUND Services for the elderly based on health-enabling technologies promise to contribute significantly to the efficiency and effectiveness of future health care. Due to this promise, over the last years the scientific community has designed a complex variety of these valuable innovations. A systematic overview of the developed services would help to better understand their opportunities and limitations. OBJECTIVE To obtain a systematic overview of services for the elderly based on health-enabling technologies and to identify archetypical service categories. METHODS We conducted a literature review using PubMed and retrieved 1447 publications. We stepwise reduced this list to 27 key publications that describe typical service archetypes. RESULTS We present six archetypical service categories, namely handling adverse conditions, assessing state of health, consultation and education, motivation and feedback, service ordering and social inclusion and describe their implementation in current research projects.
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Affiliation(s)
- Wolfram Ludwig
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig-Institute of Technology and Hannover Medical School, Muehlenpfordtstr. 23, 38106 Braunschweig, Germany.
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Ludwig W, Wolf KH, Duwenkamp C, Gusew N, Hellrung N, Marschollek M, Von Bargen T, Wagner M, Haux R. Health information systems for home telehealth services – a nomenclature for sensor-enhanced transinstitutional information system architectures. Inform Health Soc Care 2010; 35:211-25. [DOI: 10.3109/17538157.2010.534212] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bibliography. PROGRESS IN PALLIATIVE CARE 2010. [DOI: 10.1179/096992610x12624290276386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Durrani H, Khoja S. A systematic review of the use of telehealth in Asian countries. J Telemed Telecare 2009; 15:175-81. [PMID: 19471028 DOI: 10.1258/jtt.2009.080605] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted a systematic review of the literature on telehealth in Asia. The Medline database was searched, together with three specialist journals, for peer-reviewed articles published in the ten years to June 2007 which were related to any telehealth application involving one or more Asian country. Out of the 1504 abstracts retrieved, 109 articles were selected by two independent reviewers for the final review. The number of published articles on telehealth in Asia increased during the review period. The largest number of studies were conducted in Japan (37%). Most telehealth applications were based on the store-and-forward modality (43%), with 35% using videoconferencing and 15% using a hybrid approach. Most of the studies were descriptive (75%) and only eight included a control group against which telehealth was compared. The most common means of telecommunication was ISDN lines, which were employed in 32% of the studies. Some 40% of the studies mentioned improved quality of health care; about 20% mentioned improved access to health care. Although most studies mentioned cost, only 13 of them assessed resource utilization and cost. The overall findings gave a generally optimistic picture of telehealth in Asia. However, there is a lack of good quality studies.
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Affiliation(s)
- Hammad Durrani
- Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan.
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